West Virginia Office of Miners' Health Safety and Training

Permit Applications and Reporting Forms
for 
Independent Contractors
 

The following links are intended to provide the West Virginia Mining industry and the miners of the state with downloadable versions of the common applications and documents required by WVMHS&T.   Additional documents will be added as necessary. General descriptions and instructions are listed with the form links.
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Permitting Application Forms - Independent Contractors 

To simplify the permitting process for Independent Contractors, all necessary permit applications are available as a Permit Package. In addition to the permit package, you will need to file a Comprehensive Mine Safety Program, see the links below.  All contractors will use the first two downloads, and you will need to select the appropriate Generic Safety Program download for a total of three downloads for the entire permit package.           Note:  Please see the section below "Reporting Forms" for permitted Independent Contractors.

  1. Instructions and Permit Package for New Independent Contractors.
    Permit Package (all Contractor permit applications Revised October 2012 (for all types of new Contractor Permit Applications)

    Certificate of Approval update sheet - If you need to add job duties to your contractor permit after the initial permit has been issued, you MUST use the attached form and submit it to the Charleston Office.  Once compliance is reconfirmed, the new duties will be added to the Extension of the Certificate of Approval and returned to you.  If you have questions, contact the permitting office.   COA Update certificate
     
    Instructions and Permit Package for new Independent Contractor QUARRY ONLY 
    Quarry only contractors are NOT allowed to work on coal mine property

    Permit instructions and application

  2. Initial Submittal Form for filing of a Comprehensive Mine Safety Program (CMSP).
    Initial Submittal Form - CMSP   (for all types of new Contractor Permit Applications
     

  3. In addition, all new contractors will need one of the following for their written Comprehensive Mine Safety Program to be filed with the initial Submittal Form:

Application for Exemption/Renewal of Exemption (PDF) (Fillable Form)  from the requirements for the independent contractor certificate of approval.

Independent Contractor Annual Permit Extension Forms:  The Annual Contractor Permit Extension Application Package below contains the forms necessary to apply for an annual extension of the independent contractor permit.

 2017 ANNUAL CONTRACTOR PERMIT EXTENSION APPLICATION PACKAGE (PDF)   

Application for Approved Inactive Status    (Fillable Form)   Independent Contractors

YOU MUST RENEW YOUR PERMIT ANNUALLY TO BE ABLE TO FILE THE APPLICATION FOR THE APPROVED INACTIVE / RETURN TO ACTIVE STATUS. 

Do not fax your extension renewal forms.  Your $100 fee must accompany your application,  or sent by email with a copy of the electronic online payment emailed with your application.  Incomplete forms, missing forms, or forms that do not have appropriate signature will cause a delay in the processing of your renewal.

Upon completion you can submit by:

EMAIL:
(only applications that have paid $100 extension renewal fee online, confirmation of payment must be emailed with renewal application forms.  To make an online payment  CLICK HERE

Company Names:   A-J and Numbered send to: Tina.M.Whitt@wv.gov

Companies Names: K-Z send to:  Tina.M.Whitt@wv.gov

 

US MAIL AND OVERNIGHT:

WV OFFICE OF MHST, #7 PLAYERS CLUB DRIVE - SUITE 2, CHARLESTON, WV 25311-1626


Reporting Forms

Injury/Accident Report (PDF) (WORD FORMAT) The Injury/Accident form is a two sided form and is to be used for reporting all types of mining accidents.  Three copies will need to be filed--follow the instructions on the first page.

Contractor Quarterly Reporting Form (PDF) *(PDF-FILLABLE FORM) (WORD FORMAT) Independent Contractor Quarterly Reporting form.
 

*SOME VERSIONS OF ADOBE ACROBAT WILL ALLOW YOU TO SAVE FILLABLE PDF FORMS.  IF YOU DON'T HAVE THE VERSION
  THAT ALLOWS YOU TO SAVE; YOU CAN STILL USE THE FORMS.  SIMPLY COMPLETE THE FORM AND PRINT IT.

Title 56 - Series 10  Regulation Governing Reporting Requirements for Independent Contractors requires all Independent Contractors to report quarterly **activity. 
**Zero Activity or No Activity must be reported.

Note: Monthly Reports may be filed electronically. For more information and to apply for this service use the following link:

Apply for on-line reporting access.  

*SOME VERSIONS OF ADOBE ACROBAT WILL HAVE THE OPTION FOR YOU TO SAVE FILLABLE PDF FORMS.  IF YOU DON'T HAVE THE VERSION THAT ALLOWS YOU TO SAVE; YOU CAN STILL USE THE FORMS.  SIMPLY COMPLETE THE FORM AND PRINT IT.


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Note: The information obtained from these documents is accurate to the best of our knowledge and is not a substitute for current mining laws or regulations.  The state is not liable for any damages resulting from any information that unintentionally may be inaccurate or untimely.

If you don't find the form you need, or if you have accessibility issues with our forms, please contact us (see the link below) and we will assist you. We have attempted to make our forms accessible as required by state and federal regulations.

Date this page was last updated:  10/13/2017

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